Nebraska State Court Form NOTICE: ASSUMPTION OF GUARDIANSHIP AUTHORITY BY STANDBY GUARDIAN AND ACCEPTANCE CC 16:2.210 IN THE COUNTY COURT OF COUNTY, NEBRASKA Ward/Incapacitated Person I, , state under oath: The death of the uardian The uardian3. I understand that I must comply with Neb. C247 6-1443.01 before I can act on behalf of theward and/or incapacitated person. 4.Please mark one of the following (A, B, or C) and complete the additional questions, if any, for the section you marked: A)I do have possession or control of the ward222s/incapacitated person222s money, assets,possessions or income (including social security or other benefits) and the estimated value is:$.B)I do not have possession or control of the ward222s/incapacitated person222s money, assets, Case American LegalNet, Inc. www.FormsWorkFlow.com possessions or income (including social security or other benefits). The person who has possession or control of the ward222s/incapacitated person222s money, assets, possessions or income (including social security or other benefits) is AND I have talked to the person in charge of the ward222s/incapacitated person222s money,assets, possessions or income (including social security or other benefits) AND I am satisfied that the funds are being handled properly. I am not satisfied that the funds are being handled properly because I have not talked to the person in charge of the ward222s/incapacitated person222s money, assets, possessions or income (including social security or other benefits)because C) The ward222s/incapacitated person receives no money, assets, possessions or income(including social security or other benefits). ACCEPTANCE OF APPOINTMENT AS GUARDIAN I, accept appointment as guardian of Name of guardian(s) Name of ward/incapacitated person and swear that I will perform, according to law, all duties as guardian. I acknowledge my responsibilities as guardian by initialing all of the following: Acknowledgments before Letters are issued to establish my authority to serve as guardian: I shall complete all background checks as required by Neb. Rev. Stat. 24730-2602.02 and Neb. Ct. Rule 2476-1449. I shall file with the court the Guardian/Conservator General Information form (CC 16:2.4) and an Address Information form (CC 16:2.5). American LegalNet, Inc. www.FormsWorkFlow.com I shall file with the court an Inventory and Affidavit of Due Diligence form (CC 16:2.9) of the ward222s/incapacitated person222s assets. If the court requires a bond, I shall file proof of that bond with the court. Acknowledgments after Letters are issued: I shall file with the court an Acknowledgment of Financial Institution form (CC 16:2.6) showing that I gave a copy of my Letters to all financial institutions where the ward/incapacitated person has accounts. I shall also file with the court a (confidential) Personal and Financial Information for Guardianships and Conservatorships form (CC 16:2.23) with full account numbers and printouts of all assets and account numbers. Within 90 days of my appointment I shall complete a guardianship/conservatorship training class and file proof of completion with the court. I shall file my etters of Guardianship with the Register of Deeds in any county where the ward/incapacitated person has real property or an interest in real property. One year after my appointment and every year thereafter, I shall file with the court: 1.Annual Report of Guardian on Condition of Ward (CC 16:2.14).2.Updated Inventory (CC 16:2.45).3.Annual Accounting (CC 16:2.44).And, if I have possession of the ward222s/incapacitated person222s assets: 4.Certificate of Proof of Possession (CC 16:2.13 ). If any funds are restricted, the bank ordepository must indicate a restriction to the account on the certificate showing 223No withdrawalswithout court order.224 5. Copies of all bank statements and/or brokerage statements for the dates covered by theaccounting. If full account numbers, social security numbers, dates of birth or other personalinformation appear on the bank statements and/or brokerage statements I shall black out all butthe last four digits before sending them to the interested . 6.Personal and Financial Information for Guardianships and Conservatorships form (CC 16:2.23)showing complete account numbers of accounts, etc. listed on Inventory and Certificate of Proofof Possession. This form contains confidential information and is not shared with the partiesexcept by court order. American LegalNet, Inc. www.FormsWorkFlow.com I acknowledge all of the documents, except the Personal and Financial Information for Guardianships and Conservatorships form, shall be sent to all interested along with Notice of Right to Object Form (CC 16:2.16). I acknowledge that I shall file with the court a Certificate of Mailing (CC 16:2.24) showing I mailed all of the documents to all interested by first class mail, postage pre-paid. I shall notify the court of the change of address of the ward/incapacitated person within three days of the change. I shall not move the ward/incapacitated person to a location outside of the State of Nebraska without court permission. I shall notify the court of the ward222s/incapacitated person222s death within three days. I shall file with the court a Notice of Newly Discovered Asset form (CC 16:2.18) within 30 days after I become aware of any additional assets, gifts, awards, settlements or inheritances over $500.00 not disclosed in the most current inventory. I shall not make any ATM withdrawals and/or receive cash back from a debit transaction without a court order. I have reviewed the above with my attorney (if I have one) and I have received all forms necessary to comply with the above and I have no further questions of my attorney. (If you do not have an attorney please indicate 223not applicable224 and go to next acknowledgment.) I have received the forms needed to comply with the above requirements. (If you do not have an attorney, you may get the forms from the clerk222s office or on the Nebraska Supreme Court website, .) Date Signature(s) of Guardian(s) Print or Type Name of Guardian(s) Bar Number and Firm Name (attorneys only) Street Address/P.O. Box of Guardian(s) City/State/ZIP Code of Guardian(s) Phone of Guardian(s) E-mail Address of Guardian(s) American LegalNet, Inc. www.FormsWorkFlow.com State of ) ) ss. County of ) The foregoing instrument was acknowledged before me by , this Name day of , . Day Month Year Notary Public (Signature of Person Taking Acknowledgment) My commission expires: American LegalNet, Inc. www.FormsWorkFlow.com NOTICE OF RIGHT TO OBJECT TO THE STANDBY GUARDIAN: As standby guardian, you must complete and mail this form to all interested and file it with the court. You are notified that , standby guardian, has filed the following in the above referenced case on . Date document(s) filed Notice: Assumption of Guardianship Authority by Standby Guardian and Acceptance Other: If you object to the contents or accuracy of these filings, you may file an objection and request a hearing before the court. You have 10 days from the date these documents were filed with the court to complete and file the Objection from which can be obtained on the Nebraska Supreme Court website, . Date Signature(s) of Standby Guardian(s) Print or Type Name of Standby Guardian(s) Bar Number and Firm Name (attorneys only) Street Address/P.O. Box of Standby Guardian(s) City/State/ZIP Code of Standby Guardian(s) Phone E-mail Address American LegalNet, Inc. www.FormsWorkFlow.com CERTIFICATE OF MAILING TO THE STANDBY GUARDIAN: You need to complete and file this form with the court showing that you mailed the required documents marked below to all the interested you list below. I, , swear or affirm, under the penalties of perjury, that I have filed the Notice of Standby Guardian and the required forms marked below with the court and that on I mailed copies of the forms marked below to all interested persons* and bonding company, if any, at the addresses set forth below: Assumption of Guardianship Authority by Standby Guardian and Acceptance Notice of Right to Object (CC 16:2.16) NAME ADDRESS See attached (more names and a